1. Field of the Invention
The present invention relates generally to computerized medication management and dispensing stations. More particularly, the present invention relates to a system, method, and apparatus for controlling the dispensing and inventory of anesthesiology items in a health care institution.
2. Description of Related Art
Medication management in anesthesia presents a challenge for both the pharmacy and the anesthesia departments in health care institutions. Anesthesia requires open, unrestricted access to many medications, including narcotics as well as supplies. Pharmacies, on the other hand, must control access to medications and impose security measures. Organizations such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Drug Enforcement Agency, and the State Boards of Pharmacy require strict documentation and record keeping of narcotic usage. The JCAHO provides accreditation to member hospitals. In order to earn and keep the JCAHO accreditation, hospitals must adhere to strict access and control policies for medications or risk potential fines and possible shut down of the facility. Fines related to improper management of narcotics in one operating room can be $15,000.00 or more per offense. A study found that 11% of all hospitals reviewed by the JCAHO received a recommendation for improvement based on improper handling of narcotics.
The pharmacy is responsible for medications, particularly from a regulatory perspective, but is able to manage the medications only remotely. As a consequence, a serious responsibility gap exists in medication control from the time the medications are issued to anesthesiologists until the end of the day when remaining medications are returned. Complying with federal regulations is often a tedious task. Anesthesia records are often incomplete with respect to accurate medication usage documentation during and after a procedure. Current methods of anesthesia narcotic medication management are labor intensive for pharmacists and anesthesiologists, often leading to costly errors. Currently, narcotics are generally tracked in one of two fashions.
A first method of tracking narcotics, the satellite pharmacy, is used at some of the larger hospitals. Affluent hospitals often provide a satellite pharmacy that services the special needs of the operating room. The anesthesiologist signs out narcotics from the satellite pharmacy by going to the pharmacy and interacting with a pharmacist. If a pharmacist is not available, one must be paged. The anesthesiologist returns to the satellite pharmacy when a free moment is found to reconcile the unused medications with a pharmacist. Reconciling unused medications requires documenting on the patient record or returning to the pharmacy all medications that were signed out by the anesthesiologist. The pharmacy disposes of contaminated medications (referred to as xe2x80x9cwastexe2x80x9d) or returns unused medications to stock. This process is time-consuming and cumbersome to both the pharmacy and the anesthesiologist. The task requires a pharmacist to be available at all times that the operating room is in operation. Anesthesiologists must take time away from patient care to reconcile medication usage with the pharmacy. To mitigate these constraints, anesthesia and nursing staff have unsupervised access to the satellite pharmacy during off hours. The burden of narcotic tracking, however, still falls on the pharmacy during these off hour periods and the healthcare facility is exposed to potentially severe regulatory agency repercussions.
Satellite pharmacies are becoming rare due to the expense and overhead of running a specialized pharmacy. As an alternative, many hospitals are using a second method of tracking narcotics called the tackle-box method. The tackle box is a small, locked container that is prepared by the main pharmacy for each anesthesiologist. The anesthesiologist picks up his or her tackle box in the morning from the main pharmacy or from a locked room in the operating room. The location usually depends upon the pharmacy""s delivery capabilities. The tackle box usually contains a usage sheet where the anesthesiologist records the medications that were used, the patients on which the medications were used, and the quantities dispensed. The completed sheet and unused medications are returned at the end of the day to the main pharmacy or to the locked room. The pharmacy must inspect each medication record to insure accuracy and compliance. Any inconsistencies must be addressed with the anesthesiologist. However, the inconsistencies may not be addressed for several days at which point the anesthesiologist may not remember the exact circumstances surrounding the medication discrepancy. The hospital is in direct violation of the regulations until the discrepancy is resolved.
Attempts to automate the medication management process in anesthesia have been made. One product that is currently available is a semi-automated tackle-box system of narcotic medication control made by Secure-1, Inc. of Hamilton, Ohio. A small (about the size of a loaf of bread) metal box with a LCD screen and keypad on its face is used to perform narcotic medication control. The anesthesiologist signs out a box from a storage location. After the box has been removed from the storage location, only the anesthesiologist who signed out the box may open it. Once open, all the medications, including narcotics, are readily accessible. Documentation is provided via the small LCD screen and keypad. Dosages are recorded in the system by time and patient. Although the system provides some electronic information capture, there is still much legwork to be done. First, the anesthesiologist must go someplace to sign out the box. Because of the small size, only narcotics may be stored in the box. The anesthesiologist must gather the required non-narcotics via the old methods described abovexe2x80x94either through a satellite pharmacy or a medication cabinet located somewhere outside the operating room. When a case is over, the anesthesiologist must return the box to its storage location where the pharmacy retrieves it to verify and refill contents usage. This product still requires a great deal of manual labor to complete the tracking process. The anesthesiologist is required to carry the box throughout the day. In addition, the anesthesiologist must personally remove the box from a storage location (e.g., outside the operating room) and return it to the same storage area at the end of the day.
The above two scenarios form the basis for medication management in the operating room today. Each requires both time and people to complete the tracking process. Even in a perfect environment, mistakes are made, medications are not documented, documentation is not accurate, or items are diverted without a record. Often, the mistakes are due to uncontrollable events that occur during a procedure. In some cases, an anesthesiologist may require additional medications not anticipated prior to a case. A circulating nurse must then leave the procedure room to retrieve the needed item. This requirement adds unnecessary and costly delays to the procedure. Whatever the case, the result is inaccurate medication usage documentation.
In addition to control of narcotic medications, management of non-narcotic medications and supplies is often inefficient and leads to costly errors. To manage non-narcotic medications and supplies, anesthesiologists typically use a system separate from narcotic management. Anesthesiologists employ a non-secured, non-automated mobile drawer cart, often a Blue Bell Cart or a Sears Craftsman tool chest, to store these non-secured items. Narcotics are not stored in these carts because the cart is not locked. Therefore, a separate system for narcotic management is still required. Typically, every operating room has its own cart so that non-narcotics and supplies are readily available for use by any anesthesiologist using the room.
This non-automated, non-secured practice often results in errors in patient billing and stock-outs (i.e., depletion of the entire inventory of a particular item). Stock-out risks cause anesthesiologists to overstock all medications and supplies in the carts, thus incurring a much greater storage cost than necessary. If an operating room has anesthesia technicians on staff, then the responsibility of refilling the carts falls to them. However, due to cost cutting measures, few facilities have the luxury of anesthesia technicians. The responsibility of restocking the carts then falls to operating room technicians for supplies and the pharmacy or nursing for non-narcotics, further adding to their non-patient care oriented responsibilities.
Another factor that makes tracking difficult is the manner in which an anesthesiologist works. An anesthesiologist""s workflow is very different from that of a nurse working on a general care floor of the hospital. Typically, an anesthesiologist collects all needed medications before a case begins. The medications are prepared by a pharmacy or satellite pharmacy and provided in a tackle box. Alternatively, the doctor may retrieve narcotics from a locked cabinet. In either case, the anesthesiologist must take a significant amount of time to prepare for a case. In many cases, the anesthesiologist requires additional medications or additional quantities of a medication that were not anticipated before the case began. To address these problems, the anesthesiologist sends the circulating nurse out of the procedure room to gather the required medication. This time-consuming process delays the procedure.
Another factor that makes the tracking problem complex is that some medications may not be used during a procedure. Unlike in a general care unit, when medications are signed out by an anesthesiologist, they are not necessarily going to be administered. An anesthesiologist works within a given set of medications and uses those that he or she deems necessary for the given conditions of the patient. The medications that are not used during the procedure must be returned to pharmacy or disposed of (i.e., xe2x80x9cwastingxe2x80x9d).
Another complicating factor in the tracking process is that the practice of anesthesia uses a small number of medications. Most of them are non-controlled. The types of medications remain relatively constant for each type of case. Pharmacies typically provide anesthesia drug packs or kits for certain cases such as cardiac, neuro, critical care, pediatric, and general to address these medication and supply problems. Anesthesiologists are accustomed to working with such kits and expect such kits to be readily available.
The present inventionxe2x80x94the Anesthesia Cartxe2x80x94is a computerized medication and supply dispensing station that addresses anesthesia medication management and tracking problems. The Anesthesia Cart is a mobile cart that securely stores all narcotic medications, non-narcotic medications, and supplies (collectively, anesthesiology items or items) for anesthesiologists in one complete system. Items may be stored in secured drawers that remain locked at all times and require the input of specific information each time they are accessed (e.g., for storing narcotics), semi-secured drawers that remain locked until a user logs in to the system (e.g., for certain types of non-narcotics and supplies), and unsecured drawers that are always unlocked (e.g., for non-narcotics and supplies). The unit may be placed in each operating room of a healthcare facility and replaces current anesthesia storage cabinets. It also adds several valuable features such as tracking features. The system automates patient usage records, documents waste, manages inventory levels, and tracks the anesthesiology items that have been removed from the station, the time of removal, who removed them, and to whom they were administered. The tracking features include information regarding practitioner, patient, procedure, and medication or supply item. An automated account of medication usage may be created that reports on effectiveness during a case as well as comparisons between practices of the different doctors on staff. The reports may be based on procedure type, practitioner, patient, or any other piece of data captured by the system.
Many of the problems with current tracking methods are addressed. Operation of the present invention is extremely intuitive and is conducive to the anesthesiologist""s workflow. Medication or supply usage is recorded at the time the anesthesiologist confirms an administration of an item rather than at the time of removal from the station. The invention stores kits containing multiple items, individual line items, or a mixture of both so that the anesthesiologist may administer the medications or use the supplies that are appropriate for the given conditions of the patient. Additional functions for set up, loading, refilling, unloading, and performing inventory operations are also supported.
The present invention is a cabinet supported by wheels, casters, or rollers for mobility. The cabinet is equipped with a control unit comprising a computer, a monitor (preferably, an illuminated touchscreen), and a keyboard to provide access to the medications and supplies that are stored in the drawers of the cabinet. An anesthesiologist interacts with the control unit via the touchscreen monitor and/or keyboard to enter and review patient and case information, to access the medications and supplies stored in the cabinet drawers, and to reconcile item usage (e.g., record the assignment, return, waste, or transfer of medications or supplies).
To use the present invention, an anesthesiologist logs into the station""s computer, removes one or more anesthesiology items, and after administration of the anesthesiology items, documents item usage. Documenting item usage includes assigning items to a case, returning items, wasting items, and transferring items. Alternatively, the anesthesiologist may log into the stations"" computer and select a case so that anesthesiology items are assigned to the selected case as they are removed. The control unit of the station is adapted to capture case information as well as information regarding the anesthesiologist(s) associated with the case. Case information includes information about the anesthesiology items used for a specific procedure associated with a patient including the medications that will be or have been administered to the patient. Case information may be entered either before or after removal of items from the cart. It is important to note, therefore, that the anesthesiologist is not required to select a case prior to removing anesthesiology items from the cart. This flexibility in determining when anesthesiology items may be documented (i.e., after items have been removed or as items are being removed) is unique to the present invention.
When the anesthesiologist is ready to administer the medications or supplies to the patient, he or she selects an item to be removed from a list of medications or supplies appearing on the screen. If the item is in a secured drawer (e.g., a narcotic), it is made available for removal. Each removal of an item from the cabinet, whether from a secured or unsecured drawer, is associated with the anesthesiologist who has logged in to the station""s computer. If the anesthesiologist has selected a case, the items are also assigned to the selected case as they are removed. For items removed from secured drawers, the system prompts for information based on the medications removed, acting as a reminder to the anesthesiologist to insure proper documentation. This documentation process may be done for any previously removed item at any time during the procedure or at a later time. Following completion of the documentation process, the captured data provides the pharmacy with an electronic record of each medication""s usage during a case. If an anesthesiologist fails to document usage, the pharmacy may then check with the anesthesiologist to determine why the anesthesiology item use has not been reconciled.
The present invention provides significant advantages over the prior art. First, the station is mobile and may hold all medications required for a procedure in the room. An anesthesiologist may locate medications and supplies quickly and easily as they are needed. Using the present invention, the anesthesiologist no longer needs to stand in line at a satellite pharmacy or carry around keys to a narcotic room or use simultaneous processes to obtain needed supplies. Second, the documentation process is facilitated with the real-time, interactive system of the station. The necessary information is collected and processed as anesthesiologists assign items to cases. Third, the reporting capabilities provide the pharmacy and administration with accurate drug practice information. Health care institutions that use the present invention feel secure that required items will be immediately available and that medication and supply usage documentation will be completed properly. The present invention saves hours of unproductive legwork and manual documentation that are required by prior art systems.